SYPHILIS (Primary and secondary) - Case rates, by sex, and congenital syphilis (under 1 year) cases, United States, 1970-1984

1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984

'Primary and secondary syphilis.

YEARS

CONGENITAL SYPHILIS < 1 YEAR

Trends for early congenital syphilis (CS) have usually paralleled the trends for primary and secondary syphilis among women. In 1984, although the rate of infectious syphilis decreased, the actual number of reported cases of CS increased.

Factors contributing to the sustained level of early CS since 1981 may include an increase in the incidence of early infectious syphilis among pregnant women, lack of availability of prenatal care, and failure of the prenatal-care system to provide timely serologic testing and prompt follow-up. The increase in cases noted in 1984 is attributed to the above factors and also to improved surveillance due to use of a new CS case analysis form.

Reported cases of congenital syphilis (CS) for all ages decreased from 17,600 in 1941 to 326 in 1984. Neonatal mortality due to syphilis has declined 99% since the 1940s.

The major decrease in the total number of reported cases of CS has occurred in the number of late CS cases (cases reported for children over 1 year of age). This number has decreased from 1,608 in 1970 to 79 in 1984.

The number of cases of early CS (cases reported for children less than 1 year of age) decreased to 107 in 1978 and then increased slowly in the past 6 years. The proportion of cases of early CS to total cases of CS has steadily increased from 17.7% in 1970 to 75.8% in 1984.

The annual tetanus case rate has remained relatively stable since 1976. Seventy-four cases of tetanus were reported in 1984 in the United States. In addition, 10 cases were reported from Puerto Rico. Only two (2.7%) of the 74 U.S. cases occurred in completely immunized individuals (persons having either completed a primary series or received a booster dose within the last 10 years). An acute injury was identified in 52 (70%) of the cases. Among the remaining 22 cases not associated with an acute wound, six were associated with an abscess, blister, or infection; three occurred in IV drug users; two were associated with dental conditions; two, with gangrene, and two, with skin ulcers. In seven cases no associated condition was identified.

Of the 74 tetanus cases reported in 1984, 39 (53%) occurred in persons 60 years of age or older. This is consistent with serosurvey results indicating that one-half to two-thirds of persons over 60 years of age have inadequate levels of circulating antitoxin. Health-care providers should ensure that their elderly patients complete their tetanus and diphtheria vaccination schedules and should adhere to current recommendations for tetanus prophylaxis during the management of acute wounds. Two cases of tetanus (California, Texas) occurred in neonates, both born to mothers with no known history of prior immunization.

TOXIC-SHOCK SYNDROME Cases, by month of onset, United States, 1979-1984

As of June 1, 1985, 262 cases of toxic-shock syndrome (TSS) with onset in 1984 had been reported to CDC. This brings to 2,815 the total number of cases that have been reported; with 890, 586, 399, and 321 cases occurring in 1980, 1981, 1982, and 1983, respectively. Of these, 2,669 cases were in females, and 146 were in males. Cases have been reported from all 50 states. Of the 1984 cases, 2.7% were fatal, as were 2.8% in 1983 and 1982, 3.2% in 1981, and 4.7% in 1980. Nonmenstrual TSS accounted for 27% of the reported 1984 cases, up from 7% in 1980. TSS continues to be reported primarily among women and among white non-Hispanics.